Septic shock

Septic shock is accompanied by profound cardiovascular alterations, including a decrease in vascular tone, hypovolemia, and myocardial depression. Hence, the hemodynamic treatment represents a true challenge for intensivists because all of these mechanisms of shock can be associated, and at any given moment the dominant mechanism may be different. Making the correct diagnosis thus becomes somewhat complicated, especially with adapted treatment. By its ability to assess the problem in a step-by-step fashion and independently of the different variables of cardiovascular function, echocardiography is particularly adapted to the situation. The role of echocardiography in septic shock is to evaluate fluid responsiveness and document whether left and/or right ventricular dysfunction are present and are contributing to circulatory failure. Indeed, it is quite common that left, but also right, ventricular dysfunction are observed, but these often do not compromise the hemodynamic response to sepsis. It one-third of patients in septic shock, cardiac dysfunction becomes a limiting factor. To differentiate between asymptomatic and symptomatic myocardial dysfunction, it is useful to measure cardiac output and evaluate its adequacy to oxygen demand. © 2011 Springer-Verlag Berlin Heidelberg.